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There is a need for tools to decrease cancer patients’ and survivors’ long-term symptom burden. Complementary strategies, such as meditation, can accompany pharmacologic therapy to improve symptoms. Although support programs with targeted content have wider reach, higher adherence, and greater impact, there are no consumer-based meditation apps designed specifically for cancer.
This study aimed to gather information to advise the development of a cancer-specific meditation app in a small convenience sample of cancer patients and survivors who currently use the Calm app.
Adult cancer patients and survivors who are Calm users (N=82) were recruited through the Daily Calm Facebook page. Participants completed a Web-based survey related to Calm app use and satisfaction, interest in and ideas for a cancer-specific Calm app, and demographic characteristics. Open-ended responses were inductively coded.
Participants were aged between 18 and 72 years (mean 48.60 years, SD 15.20), mostly female (77/82, 94%), white (65/79, 82%), and non-Hispanic (70/75, 93%), and reported using Calm at least 5 times per week (49/82, 60%). Although rates of satisfaction with current Calm components were high (between 65/82, 79% and 51/81, 63%), only 49% (40/82) of participants used guided meditations that they felt specifically helped with their cancer-related symptoms and survivorship, and 40% (33/82) would prefer more cancer-related content, with guided meditations for cancer-specific anxieties (eg, fear of recurrence; n=15) and coping with strong emotions (n=12) being the most common suggestions. A majority of participants (51/82, 62%) reported that they would be interested in becoming a member of a Calm cancer community (eg, in-app discussion boards: 41/46, 89%; and social media communities: 35/42, 83%). Almost half of the participants (37/82, 45%) reported that they would benefit from features that tracked symptoms in concurrence with app usage, but respondents were divided on whether this information should be shared with health care providers through the app (49/82, 60% would share).
Responses suggest ways in which the current Calm app could be adapted to better fit cancer patients’ and survivors’ needs and preferences, including adding cancer-specific content, increasing the amount of content focusing on coping with strong emotions, developing communities for Calm users who are cancer patients and survivors, and including features that track cancer-related symptoms. Given differences in opinions about which features were desirable or would be useful, there is a clear need for future cancer-specific apps to be customizable (eg, ability to turn different features on or off). Although future research should address these topics in larger, more diverse samples, these data will serve as a starting point for the development of cancer-specific meditation apps and provide a framework for evaluating their effects.
In 2018, approximately 1.7 million people were diagnosed with cancer in the United States [
According to a systematic review of surveys conducted in 18 countries across Europe, North America, and Oceania, meditation is the most common complementary strategy for symptom management among cancer survivors [
Smartphone-based meditation apps are a resourceful and novel way of delivering meditation practices for symptom management to cancer patients and survivors [
Despite the growth and promise in using mobile apps to deliver interventions, most empirically supported apps have been developed by the investigator within the context of specific research [
A recent review found that there were approximately 150 mobile apps for cancer patients and survivors offering mostly educational content and information [
There are more than 500 mindfulness-based mobile apps available to the consumer (eg, multiple types of meditation, breathing exercises, music and sounds, and movement) [
Despite the variety of content offered and a basis in scientifically validated clinical stress reduction theories [
The purpose of this study was to conduct formative research in a small convenience sample of cancer patients and survivors who use Calm to gather information (ie, perceptions, satisfaction, and suggestions) to advise the development of content and features that would better meet the needs and preferences of this population. Data from this study may inform future design for consumer-based apps that want to target specific populations and provide a framework for evaluating their effects within those populations.
The Institutional Review Board at Arizona State University (STUDY00010456) approved the study. All participants provided electronic consent before participating in the survey. The dataset generated or analyzed during the study is available from the corresponding author upon request.
This was a cross-sectional descriptive study. Participants were recruited from August 1 to 12, 2019, using a post on the Calm Facebook Community page asking users who had a past or current cancer diagnosis to participate in a survey. If interested, potential participants were provided a link to complete an eligibility screening confirming that they currently or previously had a cancer diagnosis and their age. Eligibility criteria were (1) having had a cancer diagnosis and (2) aged 18 years or older. Those who were eligible were able to move on to the survey questions (see
The survey was developed by 3 doctoral-level researchers and a master’s-level trained public health data analyst. The survey was Web-based and delivered via Research Electronic Data Capture (REDCap) and took approximately 15 min to complete. All responses were anonymous. Participants completed 21 questions developed by the research team to learn about usage of and satisfaction with the current version of Calm, interest in and ideas for a cancer-specific version of Calm, clinical and cancer characteristics (ie, current treatment status, cancer stage, type of cancer, and type of treatments received), and demographic characteristics. Survey questions are listed in
Quantitative data were analyzed using IBM SPSS version 25.0. Responses to open-ended questions were combined and categorized by first reviewing all responses, and the categories were developed inductively based on recurrent content within responses, defined and named, and then applied to responses [
How often do you use Calm?
For each component of Calm, please rank your level of satisfaction.
Are there any meditations in Calm that have been or were specifically helpful for your cancer-related symptoms or cancer survivorship?
Are there any meditations that were specifically not helpful for your cancer-related symptoms or cancer survivorship?
How do you feel about Calm’s content overall?
Would you be more likely to use Calm if it was specifically made for cancer patients and survivors (ie, Calm for Cancer)?
Do you believe there could be components of Calm, other than what is already available, that could be specific for cancer patients and cancer survivors?
How useful do you find (Mindfulness Reminders, Tracking, and Share your Stats)?
What tools could Calm provide that would be useful to you, specifically related to having cancer or being a cancer survivor?
Calm currently has a Calm Community Facebook (FB) group. Are you a member of this group?
Would you be interested in being a member of a Calm Cancer Community or connecting with other cancer patients and cancer survivors, specifically?
If you could share your progress with managing symptoms (eg, fatigue, pain, and stress) with your doctor through Calm, would you use this feature?
Is there anything else you would like to share with us?
When were you first diagnosed with cancer?
What specific type of cancer are or were you diagnosed with?
What stage is your cancer in currently?
(i) Are you currently in treatment for cancer or have you received cancer treatment in the past?
(ii) What treatment(s) are you currently receiving/did you receive?
(iii) When did you start treatment or for how long did you receive treatment?
What is your birthdate?
How would you describe yourself (with regard to race)?
Do you identify as Hispanic or Latinx?
What gender do you identify with the most?
A total of 82 Calm users with a current or past diagnosis of cancer (ie, cancer patients and survivors) participated in the survey. Participants were aged between 18 and 72 years (mean age 48.60 years, SD 15.20). The majority of respondents identified as female (78/82, 94%), white (65/79, 82%), and non-Hispanic (70/75, 93%; see
Demographic characteristics of the sample.
Category | Value, n (%) | ||
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White | 65 (82) | |
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Asian or Asian American | 4 (5) | |
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Black, African American, or Native African | 3 (4) | |
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Native Caribbean or Afro-Caribbean Islander | 2 (3) | |
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Biracial or multiracial | 2 (3) | |
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American Indian or Alaskan Native | 1 (1) | |
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Other | 3 (4) | |
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Non-Hispanic or Non-Latinx | 70 (93) | |
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Hispanic or Latinx | 5 (7) | |
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Female | 77 (94) | |
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Male | 5 (6) |
aFor race, participants were given the option of selecting multiple responses, such that the total number of responses does not sum to 79.
More than half of participants reported that they used Calm at least five times per week (49/82, 58%), and rates of satisfaction with Calm components were generally high (see
Participants’ self-reported frequency of using Calm (N=82).
Frequency | Value, n (%) |
Less than 1 time per week | 5 (6) |
1-2 times per week | 13 (16) |
3-4 times per week | 15 (18) |
5 or more times per week | 49 (60) |
Participants’ satisfaction with current Calm components and content.
Component | Very dissatisfied, n (%) | Dissatisfied, n (%) | Neither satisfied nor dissatisfied, n (%) | Satisfied, n (%) | Very satisfied, n (%) | I do not use this component, n (%) |
Daily Calm (N=82) | 1 (1) | 0 (0) | 3 (4) | 24 (29) | 54 (66) | 1 (1) |
Meditations (N=82) | 1 (1) | 0 (0) | 6 (7) | 21 (26) | 45 (55) | 9 (11) |
Calm Music (N=81) | 1 (1) | 3 (4) | 13 (16) | 22 (27) | 29 (36) | 13 (16) |
Sleep Stories (N=82) | 1 (1) | 0 (0) | 5 (6) | 26 (32) | 31 (38) | 19 (23) |
Breathe Bubble (N=79) | 1 (1) | 1 (1) | 6 (8) | 13 (16) | 27 (34) | 31 (39) |
Calm Masterclass (N=78) | 1 (1) | 0 (0) | 8 (10) | 16 (21) | 19 (24) | 34 (44) |
Calm Body (N=78) | 1 (1) | 0 (0) | 9 (12) | 16 (21) | 14 (18) | 38 (49) |
Almost half (40/82, 49%) of the respondents reported that there were meditation options in Calm that were helpful for their cancer-related symptoms or survivorship. When asked to describe the meditation programs that were specifically helpful and explain how they helped, participants reported that guided meditation that focused on anxiety, gratitude, and stress were most helpful for cancer symptoms and survivorship (see
Participants’ reports of guided meditation content specifically helpful for cancer-related symptoms or survivorship (N=40).
Meditation content | Value, n |
Anxiety | 12 |
Gratitude | 6 |
Stress | 5 |
Letting go (eg, of fears and control) | 5 |
Breathing meditation | 3 |
Pain | 3 |
Sleep meditation | 2 |
Living in the moment | 1 |
Grief | 1 |
When asked to report whether participants enjoyed Calm’s current content overall and if they would prefer that there was more content related to cancer, 79% (65/82) of respondents reported that they enjoyed Calm’s current content. However, 40% (33/82) of participants reported that they would prefer additional cancer-related content, such as topics related to being a cancer patient (19/82, 23%), topics related to being a cancer survivor (25/82, 30%), or other topics related to cancer (22/82, 27%). Some of the participants who reported that they would prefer other cancer-related topics provided a description of the topics they would like to see (see
Descriptions of other cancer-related guided meditation content that participants would prefer for inclusion in Calm (N=22).
Meditation content | Value, n |
Strong emotions during or after cancer | 6 |
Life after cancer | 5 |
Acceptance and letting go | 4 |
Positive focus and gratitude | 4 |
Chronic illness | 3 |
Acute worrying about treatment sessions, scans, or appointments | 3 |
Visualizations about staying strong (eg, mountain in a storm) | 2 |
Bereavement | 1 |
Narrators who are cancer patients and survivors | 1 |
Cancer and pets | 1 |
More than one-third (31/82, 38%) of the participants reported that they would be more likely to use Calm if it were specifically made for cancer patients and survivors, and 73% (60/82) believed that there could be components of the app modified specifically for cancer patients and survivors, beyond what is currently offered. When asked about what kinds of meditation content could be developed specifically for cancer patients and survivors, what they would like to see, and how it would be different from what is currently available, guided meditations for cancer-specific worries or anxieties were the most common suggestions (see
When asked what participants would like to see and how it would be different from what is currently available on Calm, the most common response was the inclusion of cancer-specific content while maintaining the structure of the current Calm app (see
Participants’ suggestions for new guided meditation content for cancer patients and survivors (N=51).
Meditation content | Value, n |
Fears and anxieties specifically related to cancer | 15 |
Managing difficult and strong emotions | 12 |
Short guided meditations to use before or during treatment or scans | 7 |
Similar to current content but specifically addressed to cancer patients and survivors | 7 |
Hope for the future | 7 |
Loving and knowing your body | 7 |
Noninternally focused (eg, focus on surroundings, not on the breath or body) | 7 |
Coping with side effects of cancer and treatment | 5 |
Healing | 5 |
Living in the present | 5 |
Life after cancer | 4 |
Interactions with others and accepting their reactions | 4 |
Grief and mourning | 4 |
Positive self-image | 3 |
Visualizations | 3 |
Remaining positive | 2 |
Breathing | 2 |
Movement and getting outdoors | 2 |
Guilt | 2 |
Trust | 2 |
Participants’ suggestions for cancer-specific guided meditation content and app components (N=30).
Meditation content | Value, n |
Including cancer-specific content | 16 |
Emphasizing different topics (eg, strong negative emotions and focus on present) | 9 |
Curating current Calm content into cancer-relevant series | 7 |
Reformatting content (eg, shorter guided meditations and interactive components) | 6 |
Including content that is more personal or personalized | 5 |
Validation of differences in cancer experiences | 5 |
Content and format that reflects the chronological |
3 |
Including content related to pain management | 3 |
Including spiritual content | 2 |
When asked if they would be interested in becoming a member of a Calm cancer community or in connecting with other cancer patients and survivors who used Calm, almost two-thirds (51/82, 62%) of participants agreed. Respondents who showed interest were asked to select from a list of different forums or types of communities in which they would be interested in participating. Discussion boards (eg, blogs or chat rooms available through the app) and communities on social media (eg, Facebook and Instagram) were the most popular suggestions, with 89% (41/46) and 83% (35/42) of respondents reporting that they would be interested in these types of communities, respectively. The majority of these respondents showed interest in communities integrated into the Calm app, such as group meditation programs that allowed multiple users to meditate at the same time (33/47, 70%) and the ability to contact other users individually via app-based direct messaging (24/38, 63%).
When asked if they would be interested in other types of communities, 6 (27%) of 22 respondents responded positively. Of the 4 respondents who provided additional open-ended descriptions of other types of potential communities that they might be interested in joining, all expressed a desire for communities with a narrower target audience. Specifically, they proposed that there might be different communities for different types of cancer, such as communities focused on chronic pain; communities for friends, family members, and caregivers; and communities specifically focused on staying positive.
Participants were asked about the usefulness of Calm’s in-app tools designed to support user engagement (see
Participants’ reports of usefulness of in-app tools to support app engagement (N=82).
Tool | Not at all useful, n (%) | Mostly not useful, n (%) | Sometimes useful and sometimes not, n (%) | Mostly useful, n (%) | Very useful, n (%) | I do not use or pay attention to this tool, n (%) |
Tracking | 2 (2) | 2 (2) | 10 (12) | 19 (23) | 35 (43) | 15 (18) |
Mindfulness Reminders | 1 (1) | 1 (1) | 11 (13) | 23 (28) | 31 (38) | 16 (20) |
Share your Stats | 9 (11) | 5 (6) | 5 (6) | 9 (11) | 7 (9) | 48 (59) |
Participants were asked to select from a list of possible new features to indicate which tools Calm could provide that would be useful to them, specifically related to having cancer or being a cancer survivor (see
Participants who selected
Participants’ reports about potential app-related tools specifically useful for cancer patients and survivors (N=82).
Tool | Reported helpful, n (%) |
Calm Cancer Community (ie, engagement with others through the Calm app) | 59 (72) |
Weekly text messages with a report (ie, graph or chart) about your use of the app and how you are feeling (ie, you track your cancer specific symptoms in Calm) | 37 (45) |
Daily text messages with feedback related to how you are feeling (ie, you track your cancer-specific symptoms in Calm) with a weekly report (ie, graph or chart) | 27 (33) |
Share your weekly symptom report with your health care provider | 21 (26) |
Daily text messages with feedback related to the use of the app (ie, time spent using, etc) | 17 (21) |
Share your stats (ie, time spent using) with your health care provider | 14 (17) |
Other tools | 6 (7) |
When participants were specifically asked if they would use a feature that allowed them to share progress with managing symptoms (eg, fatigue, pain, and stress) with their doctor using the Calm app, 60% (49/82) reported that they would. Participants who reported that they would use this feature shared their ideas about how the feature would function (see
Participants’ ideas for symptom-tracking and symptom-sharing features (N=33).
Mechanism or ability | Value, n |
User-generated reports to share with health care providers | 12 |
Surveys about symptoms within the app | 7 |
Regular reports automatically sent or emailed to health care providers | 4 |
Dashboard to create customizable symptom and app usage tracking reports | 4 |
In-app feature that allows personal contact with users’ health care provider | 4 |
Integration with existing electronic health platforms within users’ health care networks | 3 |
Regular reports automatically sent or emailed to users | 2 |
Feature allowing health care provider to directly access users’ reports or data | 2 |
Responses from participants who did not desire a feature allowing them to share their symptoms with their health care provider (33/82, 40%) indicated the primary reason was that it was easier or preferable to discuss symptoms or progress in person during visits (see
Reasons for not wanting to share symptoms with health care providers through Calm (N=23).
Reason | Value, n |
Prefer to share symptoms with health care provider in person | 10 |
Concerns about privacy or confidentiality | 3 |
Already track symptoms with other methods or systems | 3 |
Tracking and sharing symptoms is not relevant to current needs | 3 |
Difficult or burdensome for self (eg, emotionally) or provider (eg, time) | 3 |
Already satisfied with communication with health care provider | 2 |
Not currently in treatment | 1 |
The purpose of this study was to conduct formative research in a small convenience sample of cancer patients and survivors who use Calm to gather information (ie, perceptions and satisfaction) to advise the development of content and features that would better meet the needs of this population. This was the first study to assess perceptions of cancer patients and survivors who use a consumer-based mobile app for meditation. Data from this study may inform future design for consumer-based apps that target specific populations and provide a framework for evaluating their effects within those populations.
Participants were highly satisfied with Calm and used the Daily Calm most frequently with high satisfaction. Calm’s guided meditations related to anxiety, gratitude, and stress were considered to be the most helpful for cancer symptoms and survivorship. However, half of the participants did not think that the guided meditations were specifically helpful for their cancer-related symptoms or survivorship, and 73% (60/82) felt that there could be components of Calm modified to be more specific to the experiences of cancer patients and survivors. Suggestions for new content were mostly related to managing difficult emotions and fears and anxieties related to cancer, enduring fears of recurrence, and loving their bodies during and after cancer. Participants were interested in being connected with other Calm users who were cancer patients and survivors. Importantly, having a support community within the Calm app was overwhelmingly the most commonly suggested in-app tool for supporting app engagement. Most participants wanted to share their Calm use and the management of their symptoms with their care providers, but some preferred to do so in person.
Calm content was well received by cancer patients and survivors. Specifically, participants appreciated the stress-, anxiety-, and gratitude-related contents. This is likely because cancer-related stress often persists well beyond the disease’s diagnosis and treatment [
Gratitude or the ability to notice and appreciate the present moment and the positive aspects of one’s life plays an important role in cultivating and maintaining well-being [
Those who felt Calm could offer more cancer-related content recommended guided meditations for coping with strong emotions that arise during cancer (eg, fear, shock, uncertainty, and isolation). In addition, respondents desired content addressing the unique challenges of life after cancer (eg, healing, trauma, and lifelong worry). There are few resources that have been specifically designed to support cancer patients as they transition out of cancer treatment or that specifically address ongoing needs of posttreatment survivors (eg, fear of recurrence, anxiety, impaired body image, fitting into their previous social roles, and fatigue) [
It is not surprising that cancer patients and survivors using the Calm app want to connect with other users. It is important to note that the participants in this study were recruited on Facebook, biasing their response to social support. However, it is also well known and documented that cancer patients and survivors turn to social support to gather resources and to assist with the coping process, as they navigate their way through cancer treatment and survivorship [
More than 80% (67/82) of participants indicated that they used the meditation tracking components within the current Calm app, and most reported that they found these features to be useful. Approximately half of the participants felt that the ability to track cancer symptoms in concurrence with Calm usage would be helpful to them. In breast cancer patients, multiple studies support the feasibility and acceptability of using mobile apps to monitor symptoms related to sleep [
Interestingly, there were divergent opinions about whether symptom information collected through Calm be shared with their health care providers, with approximately 60% (49/82) of participants indicating that they would share information with their health care providers and 40% (33/82) indicating that they would not. Apps that allow cancer patients and survivors a way to share information directly with health care providers are limited. A recent review of mobile apps for cancer found that 29 of the 151 available apps included features that allowed cancer patients and survivors to track symptoms (mainly fatigue, pain, mood, nausea, and sleep), 21 included the ability to generate graphical summaries for personal use or to share with health care providers (eg, through email or at doctor’s visits) [
To our knowledge, there is little research on the effects of patients or survivors tracking symptoms and sharing this information with their providers (either in person or using an app). A small study of cancer patients (N=9) reported that using an mHealth app with the ability to access, monitor, and share their health-related information (eg, access care-related information and sharing information during visits) with providers during visits was empowering [
The findings of this study should be interpreted in light of its limitations. First, survey participants were recruited via the Calm Facebook page. Owing to the fact that respondents were already Calm users, satisfaction with Calm was likely higher than would be observed in nonusers or users who were less engaged. However, it is notable that a substantial number of participants who were already satisfied with Calm agreed that the app could include components that better address the needs of cancer patients and survivors; this may highlight the broader appeal of a cancer-specific meditation app (eg, if individuals who do not currently use Calm but may consider using it and if it were specific to cancer). Future studies should also collect additional data about the proposed features or components of the current app that respondents were dissatisfied with and their reasons for dissatisfaction, as this information will inform future apps and potentially contribute to their long-term adherence. In addition, survey respondents were already engaged with the Calm community on social media such that the desire to connect with other Calm users may be higher than would be expected in the overall user population. The generalizability of these results may also be affected by the small sample size. To increase the potential benefits of a cancer-specific meditation app, questions about the desired features (eg, means of connecting with other users) should be further explored in larger, more diverse samples of cancer patients and survivors. Future research should also extend to others affected by cancer, such as caregivers and health care providers, who may have unique needs that could be addressed through a meditation app for cancer.
This was the first study to survey cancer patients and survivors who use Calm and participate in Calm’s Facebook group to explore the desirability of a cancer-specific meditation app and to collect information about the types of content and features that would be most helpful for these users. Respondents felt that the components, content, and tools in the current Calm app could be better tailored to meet the needs of cancer patients and survivors. There was a desire for content that addressed cancer-specific anxieties (eg, scan anxiety and fear of recurrence) and content that focused on coping with strong emotions. Many patients and survivors indicated that they would benefit from features that tracked cancer-related symptoms in concurrence with app usage, but respondents were divided as to whether this information could be shared with health care providers through the app. This highlights the need for future apps for cancer patients and survivors to be customizable such that the users have the ability to turn different features on and off. Although future research should address these topics in larger, more diverse samples, these data may serve as a starting point for the development of meditation apps for specific patient groups and provide a framework for evaluating their effects within the target populations.
Calm for Cancer survey questions.
Clinical cancer characteristics in sample.
electronic health
Health Insurance Portability and Accountability Act
mobile health
Research Electronic Data Capture
The authors would like to acknowledge Shannon Clark-Sienkiewicz for her help with drafting survey questions.
JH is currently the Director of Science at Calm. JH has been conducting research with Calm as a partner for almost 5 years before becoming the Director of Science and serving on the Scientific Advisory Board. Her role is to ensure the quality of Calm’s science. There are no financial incentives from the growth of Calm for any author. The remaining authors declare no conflicts of interest.